Provider Demographics
NPI:1356551261
Name:BALAGANI, AURABIND (DO)
Entity type:Individual
Prefix:
First Name:AURABIND
Middle Name:
Last Name:BALAGANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 JOLIET ST STE C
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2073
Mailing Address - Country:US
Mailing Address - Phone:219-322-2723
Mailing Address - Fax:219-864-9707
Practice Address - Street 1:1467 JOLIET ST STE C
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2073
Practice Address - Country:US
Practice Address - Phone:219-322-2723
Practice Address - Fax:219-864-9707
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002735A207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014648Medicaid
MS06154751Medicaid
IN200894640Medicaid
MS06154751Medicaid
LA4K626Medicare PIN